30. Addiction and Substance Abuse Flashcards
what must nurses be aware of when caring for a pt w/ substance abuse
- self awareness
- countertransference
continued use despite adverse consequences
addiction
ingestion, smoking, sniffing, or injecting of mind-altering substances
use
one or more drugs needed to function
dependence
use for purposes of intoxication, beyond intended use, can lead to dependence
abuse
sxs occurring when substance no longer used
withdrawal
process for safe withdrawal
detoxification
recurrence
relapse
what type of substance is alcohol
CNS depressant
immediate effects of alcohol
- disinhibition
- euphoria
- sedating
- CNS depressant
- potentially fatal in excess
long term effects of using alcohol
- harmful changes in liver, GI, bone density, muscles, and immune system
- permanent brain damage
- dementia (Wernicke’s encephalopathy and Korsakoff’s syndrome)
alcohol effect caused by a thiamine deficiency; causes vision impairment, ataxia, hypotension, and confusion
Wernicke’s encephalopathy
alcohol effect that causes heart, vascular, nervous system involvement; difficulty acquiring new info and retrieving memories -> causes them to make up new memories (confabulation)
Korsakoff’s syndrome
difference between Wernicke’s encephalopathy and Korsakoff’s syndrome
- Wernicke’s: comes on suddenly and needs to be treated immediately (thiamine replacement)
- Korsakoff’s: long-term ongoing problem
- Wernicke’s can lead to Korsakoff’s
effects of alcohol on the body
- peripheral neuropathy
- alcoholic neuropathy
- alcoholic cardiomyopathy (weakness heart muscle)
- esophagitis
- gastritis
- pancreatitis
- alcoholic hepatitis and cirrhosis
- leukopenia
- thrombocytopenia
- sexual dysfunction
use of alcohol during pregnancy leads to problems w/ learning, memory, attention span, communication, vision, and hearing
fetal alcohol syndrome (FAS)
manifestations of fetal alcohol syndrome (FAS)
- small for gestational size
- facial abnormalities
- poor coordination
- hyperactive behavior
- learning disabilities
- low IQ
- problems w/ daily living
- vision/hearing problems
- poor judgement and reasoning
- heart and kidney defects
- abnormal size and shape of brain
- risk for psych disorders
theories for alcohol dependence
- genetics
- biochemical: may produce morphine-like substances in the brain -> causes addition
- developmental factors
- certain personality traits play part in both development and maintenance of alcohol dependence
phase of alcohol abuse where it is used to relieve everyday stress and tensions of life
phase I: pre-alcoholic phase
phase of alcohol abuse where there are brief periods of amnesia that occur during or immediately following drinking; alcohol is now required
phase II: early alcoholic phase (blackouts)
phase of alcohol abuse where control is lost and there is physiological dependence
phase III: crucial phase
phase of alcohol abuse where there is emotional and physical disintegration; intoxicated more often than sober
phase IV: chronic phase
assessment tools for alcohol use
- Michigan alcoholism screening test (MAST)
- AUDIT questionnaire
- CAGE questionnaire (CUT, Annoyed, Guilty, Eye Opener)
usually occurs within 12 hours after abrupt discontinuation of alcohol; may include delirium tremens
alcohol withdrawal syndrome
scale used to determine management for alcohol withdrawal
clinical institute withdrawal assessment of alcohol scale (CIWA scale)
pharmacology used to ease the alcohol withdrawal period
- benzos (Librium, Ativan, Diazepam)
- antidepressants
- sleep meds
- antipsychotics
how to determine which benzos to give for alcohol withdrawal
- Librium and Diazepam have longer half life and are smoother to taper off
- Ativan given if pt has liver impairment
stage I of alcohol withdrawal syndrome
- increased HR and temp
- normal or slightly elevated BP
- slight diaphoresis
- oriented w/ no confusion or hallucinations
- mild anxiety and restlessness
- hand tremors w/ no seizures
- impaired appetite and nausea
stage II of alcohol withdrawal syndrome
- HR 100-120
- systolic BP and temp elevated
- obvious diaphoresis
- intermittent confusion and transient hallucinations
- painful anxiety and restlessness
- insomnia and nightmares
- visible tremors and rare seizures
- anorexia, N/V
stage III of alcohol withdrawal syndrome
- HR 120-140
- BP and temp elevated
- marked diaphoresis
- marked disorientation, confusion, disturbing visual and auditory hallucinations, and delusions
- delirium tremens
- extreme restlessness and panic states
- unable to sleep
- gross uncontrollable tremors and seizures common
- reject all fluid and food
complications of alcohol withdrawal
- withdrawal seizures
- alcoholic hallucinosis (12-24 hours after last drink; resolve in 24-48 hours
- delirium tremens (DTs) - most severe form of alcohol withdrawal
describe withdrawal seizures
generalized tonic-clonic confusions usually 12-48 hours after last drink
- may occur within 2 hours
- 30-40% w/ seizures progress to delirium tremens
manifestations of delirium tremens (DTs)
occurs 3-10 days following last drink
- agitation
- global confusion
- disorientation
- hallucinations
- fever
- HTN
- tachycardia
most common conditions leading to death in pts w/ DTs
respiratory failure and cardiac arrhythmias
treatment of DTs
- adequate nutrition
- medication
- multivitamin therapy
- thamine
3 medications used for DTs
- Disulfiram (Antabuse)
- Naltrexone
- Acamprosate
MOA of Disulfiram
- inhibits aldehyde dehydrogenase (ETOH oxidation)
- build up of acetaldehyde
- causes sickness if taken w/ alcohol
MOA of Natrexone
binds to opioid receptor and inhibits action of opioid drugs -> may prevent high feeling from using alcohol and decrease cravings
MOA of Acamprosate
reduces cravings by rebalancing glutamate and GABA NTs
how to prevent alcohol relapse
- psychosocial interventions
- cognitive behavioral interventions (examine thinking process that leads to alcohol use)
- motivational approaches (motivational interview -> very effective)
describe alcoholic anonymous (AA)
- major self-help organization that gives peer support, acceptance, and understanding from those who have experienced same problem
- 12 steps provide specific guidelines on how to obtain and maintain sobriety
T/F: total abstinence is the only cure for alcoholism; pt can never socially drink again
True
describe harm reduction programs
- ran by professionals to reduce consumption and work towards abstinence
- not required to turn over recovery to a higher power
describe sedatives, hypnotics, and anxiolytics
- sedatives: have calming effects on CNS
- hypnotics: induce sleep
- anxiolytics: anti-anxiety meds
found in coffee, tea, chocolate, energy drinks, diet pills, and headache remedies
caffeine
effects of caffeine
- increase person’s perceived level of energy alertness
- increase BP and may lead to increase production of cortisol
psychoactive substance found in cigarettes
nicotine
effects of nicotine
- stimulates release of adrenaline (NE)
- increases BP, HR, and RR
signs of nicotine withdrawal
- anxiety
- irritability
- depression
- difficulty concentrating
- sleep disturbances
- headaches
- increased appetite
2 medications used to help people quit smoking
- Zyban
- Chantix
types of inhalants
- volatile solvents
- aerosols
- gases
- nitrates
effects of inhalants
- euphoria
- sedation
- emotional lability
- impaired judgement
- chronic neurologic syndrome possible for long-term use
intoxication of inhalants
- respiratory depression
- stupor
- coma
- risk for “sudden sniffing death” -> suffocation or cardiac arrhythmias
what type of substance is cocaine
CNS stimulant
- increases dopamine (euphoria and psychotic sxs)
- increases NE (tachycardia, HTN, dilated pupils, and elevated temp)
- increased serotonin (sleep disturbances and anorexia)
effect of cocaine
sudden burst of mental alertness and energy; feelings of self-confidence and being in control
how long does the cocaine rush lasts
about 10-20 minutes followed by intense let-down effect that causes irritability, depression, tiredness, and craving more drug
effects of amphetamines
- CNS stimulant
- blocks reuptake of NE and dopamine w/ lesser effect on serotonin; also has peripheral nervous system effects
list of CNS stimulants
- cocaine
- amphetamines (includes ADHD meds)
- methamphetamine
- MDMA (Ecstasy)
- Rohypnol GHB, Ketamine
effects of methamphetamine
- CNS stimulant
- release of excess dopamine
- highly additive
- used in a binge and crash pattern
effects of MDMA (Ecstasy)
- increase serotonin and excess dopamine release
- causes hallucinations, confusion, depression, sleep problems, drug craving, severe anxiety, and paranoia
- possible malignant hyperthermia
what drug is also know as the date rape drug
Ketamine (odorless, tasteless, and colorless)
- when mixed w/ alcohol -> incapacitated w/ sedated euphoric effect and produces anterograde amnesia
effects of cannabis on body
- CV effects
- respiratory effects
- reproductive effects
- CNS effects
- sexual functioning
what is Marinol
FDA approved drug w/ THC in it that is given to chemo patients to stimulate appetite
effects of hallucinogens
- euphoria or dysphoria
- altered body image
- distorted or sharpened visual and auditory perception
- confusion and incoordination
- impaired judgement and memory
severe reactions to hallucinogens
- paranoia
- fear of losing one’s mind
- depersonalization
- illusions
- delusions
- hallucinations
type of hallucinogens
more than 100 different types
- psilocybin (mushroom)
- D-lysergic acid diethyl amide (LSD)
- mescaline
- numerous amphetamine derivatives
types of opioids
- oxycodone
- hydrocodone
- morphine
- fentanyl
- codeine
- heroin (type of opioid)
side effects of opiods
- constipation
- dulled senses
- slowed HR and RR
- euphoria/confusion
- dependency/addiction
- urinary retention
effects of repeated activation of opioid receptor
- euphoria
- physical dependence
- analgesia
- depression
- respiratory depression (common cause of death)
- sedation
signs of opioid overdose
- extreme sleepiness
- slow shallow breathing
- fingernails or lips turn blue-purple
- small pinpoint pupils
- slow HR and BP
what is used to treat opioid addiction
- Methadone - given over 21 days and tapered down; reduces craving and withdrawal sxs
- Naltrexone/Vivitrol (injectable form) - used for opioids and alcohol addiction
pt education after treatment for opioid addiction
- after tx -> tolerance is reduced
- if they resume using after tx -> not be able to use same amount as before -> could be lethal
management of substance use disorder
- activities to substitute substances int times of stress
- relaxation techniques
- problem solving skills
- harm reduction strategies
- 12 step programs
signs of chemical dependency in nurses
- mood swings and inappropriate behavior at work
- noncompliance w/ acceptable policies and procedures
- deteriorating appearance and job performance
- sloppy illegible charting
- alcohol on breath
- forgetfulness and poor judgement
- lying
- high achievement
- volunteering for OT or extra duties
- onset after prescription after sx or chronic illness
- FHx of alcoholism or addiction
describe gambling addiction
- non-substance related disorder
- preoccupied w/ gambling and experience aroused euphoric state during actual betting
- highly competitive, energetic, restless, and easily bored
- more likely to commit suicide and less likely to seek mental health tx
- staff education and family involvement are important
